James Gordon tells Parveen he is concerned about his partner, who seems to be struggling after the birth of their newborn baby...

“Donna seems to be really struggling. She is either at rock bottom and almost paranoid that something awful is going to happen to Emily, or she’s flying around and doing millions of things, most of which simply don’t need doing. When I try and talk to her about it she seems a bit confused. Another thing I have noticed is that she talks non-stop.”

ANSWER

Donna is exhibiting signs of postpartum psychosis (sometimes known as puerperal psychosis), which requires urgent medical attention as it is considered a medical emergency. James’s first stop with Donna should be the GP, who will be able to refer Donna to a specialist mother and baby psychiatric facility, where she can be treated while continuing to look after Emily.

If this type of unit is not available locally, Donna will be looked after on a general psychiatric ward, where she will probably not be able to have Emily with her, and James will need to make arrangements with his employer to look after his daughter and get help from family members to support him.

Once admitted to a suitable unit, Donna can expect to be put on antipsychotic and/or mood stabilising medication, the choice of which will be governed by her symptoms and whether she is breastfeeding. It can take several weeks for the condition to start to resolve and many more months before Donna will feel like herself again, although she does not need to be an in-patient for the duration of her treatment.

Once discharged from hospital, she will be under the care of her GP and a community mental health team, with health visitors keeping a watchful eye on Emily. Family support workers could also be involved. Donna will need a lot of support while she recovers, both from a practical point of view and to help her process what she has been through.

The bigger picture

The symptoms of postpartum psychosis vary hugely but can include anxiety, restlessness, insomnia, mania, depression, confusion, delusions and hallucinations. The sufferer is usually completely unaware of the changes in her behaviour, which will be markedly different to usual, and will struggle to look after herself, let alone her newborn baby.

There are some risk factors for developing the condition – previous psychotic, schizophrenic or bipolar episodes, for example, or having a close relative who has experienced postpartum psychosis – but often it is literally a bolt out of the blue. Considerably more common is postnatal depression, which affects some 10-15 per cent of new mothers and presents in a very similar way to clinical depression. Baby blues are also common but usually pass in a week or so without any treatment.

Extend your learning

• A more comprehensive list of symptoms that might be experienced can be found at www.rcpsych.ac.uk/healthadvice/problemsdisorders/postpartumpsychosis.aspx